Service reconfiguration in the department of hand surgery during the UK COVID-19 lockdown: Birmingham experience.

In early 2020, the COVID-19 pandemic swept through the UK and had a major impact on healthcare services. The Birmingham hand centre, one of the largest hand trauma units in the country, underwent a dramatic service reconfiguration to enable robust and safe provision of care that would withstand the peak of the pandemic. Streamlining our service significantly reduced patient footfall and hospital admission while preventing intra-hospital viral transmission. Many of the changes implemented have been kept as permanent adjustments to our practice as this new model of care yields higher patient satisfaction and efficacy to withstand the pressures of further peaks in the pandemic.

The changing management of primary mycotic aortic aneurysms.

OBJECTIVE: The objective of this study is to examine contemporary management of primary mycotic aortic aneurysms in a single center. We have previously reported the management of mycotic aortic aneurysms in 15 patients between 1991 and 2001, and we hypothesized that management would change in the light of the evolution of endovascular aortic repair. METHODS: A review of a prospectively collected database (2002-2009) of all patients presenting with mycotic aneurysms. RESULTS: A total of 19 aneurysms were identified in 17 patients (12 men, 5 women) with a median age of 66.2 years (range, 49-82 years). All were symptomatic, and nine had contained rupture. There were five infrarenal, two juxtarenal, three Crawford type III, four type IV thoracoabdominal aortic aneurysms, and five descending thoracic aneurysms in the series. All thoracic aneurysms were excluded by thoracic endovascular aneurysm repair. Two patients underwent visceral hybrid endografting for type III thoracic aortic aneurysm; the third was treated with open repair. Four patients underwent open type IV repair. Two of the infrarenal aneurysms were treated with bifurcated endovascular aneurysm repair, and the other three and both juxtarenals with open repair with in situ reconstruction. There were three early (17.6%) and three late deaths (17.6%). The median follow-up was 30.5 months (range, 1-102 months). CONCLUSIONS: The results of the latest series show that open surgery is still required in many cases. The introduction of endovascular techniques in the exclusion of mycotic aneurysms can be accomplished with acceptable results, and endovascular treatment has increased the therapeutic options for a difficult condition.

Bilateral symmetrical metachronous myxofibrosarcoma: a case report and review of the literature.

Soft tissue sarcomas (STS) are rare. Affected patients are at increased risk of developing a second primary malignancy, particularly another primary STS. These rarely affect the extremities, tending to occur in the abdomen, head or neck. We describe a patient with myxofibrosarcoma of the buttock who developed a second primary tumour of the same histological type in the contralateral buttock thirty months after excision. Remarkably, the second tumour was symmetrical and there were no predisposing factors or evidence of metastatic spread. The second tumour was a significant size at presentation with encasement of the sciatic nerve. Awareness of the sarcoma patient's increased risk of developing a second tumour could lead to earlier diagnosis and improved outcome. A review of the literature on multiple soft tissue sarcomas is also presented.